Archive for August 2012

In response to a story that appeared in JATB some weeks ago,entitled Childhood tuberculosis—the time for action is NOW, I have received a response from Global Health Advocates, the organisation that had originally identified the cases of Akshay and Pankaj, featured in the story. I reproduce the response below. The response has been sent to JATB by Mr Christo Mathews of Global Health Advocates.

…My colleague, Sapna Naveen, had met the parents, Mrs. and Mr. Shamlal in the last week of October (we were given their details by their doctor in the LRS) and discussed their issue with a view to getting them to speak as patient advocates at our function on the 14th of November 2011, in New Delhi. Their children – Akshay (13 yrs old) and Pankaj (5 yrs old) – were both diagnosed with XDR and the family had to lose their property in order to get treatment for the children. In early November, Sapna took the matter up with the State TB officials in Amritsar – the Deputy STO – who connected her with the State WHO RNTCP Consultant to help take this further. The WHO Consultant, most helpfully, spoke to the CTD and then urged that we send the case information to the STO, Punjab. She made us aware that it was the State TB cell’s prerogative to provide XDR medicines from their funds. We sent the letter to the STO, asking for his intervention and it was forwarded to the DTO, for action. Sapna had also requested their doctor at LRS to issue the children a medical certificate, stating that they are non-infective in order to get them re-admitted to school since the school had barred them due to their condition. The kids have since started treatment (they are getting medicines from the DTO). One has actually ‘turned negative’ and the other shows encouraging signs of improvement…

JATB thanks Christo Mathews for updating this story with the ‘happy ending’.

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I’m sure this is not something no one knows. These are historical facts. But if we were to contextualise these facts into today’s situation with the rampant incidence of TB in India, it could offer a new perspective.

I quote from Shashi Tharoor’s book Pax Indica – India and the World of the 21st Century. He writes…”From a nation that had once been among the world’s richest, and which as late as 1820 accounted (in the estimate of the late British economic historian Angus Maddison) for 23% of global GDP, we had been reduced by 1947 into one of the poorest, most backward, most illiterate and diseased societies on earth. From 1900 – 1947, the rate of growth of the Indian economy was not even 1%, while population grew steadily at well over 3.5%. Imperial rule left a society with 16% literacy, practically no domestic industry and over 90% living below what today we would call the poverty line…”

We Indians often castigate our system and our governments and accuse them of not having done enough towards progress despite our having been independent for over six decades. Without meaning to search for excuses, I believe that the real reason lies not merely in lack of good governance, but elsewhere. The above facts do point to the severe challenges an Independent India must have been faced with. It needs no great intelligence to understand that poverty and illiteracy are powerful determinants of health, or the lack of it. If, as facts demonstrate, we had 90% of our population living below the poverty line, doesn’t it also mean that ill-health, particularly TB would be a natural fall-out of the situation? Poverty would mean lack of good food, housing and affordability of healthcare. Illiteracy would mean lack of options for earning a livelihood. Both together would have predictably held the portents for a nation riddled with ill-health – malnutrition, TB etc being the most obvious and visible signs.

Having said all this, it is also important to point out that those worthy people, to whom we had trustingly handed the reins of governing our free country, should have had the foresight and wisdom to prioritise areas that were potentially vital to progress – not merely economic, but also social. Healthcare should have a been non-negotiable priority way back. If it had been, we would not have 1000 people dying of TB today. We wouldn’t have such high rates of malnutrition among children and we wouldn’t have babies dying before they had a chance to even set eyes on this wondrous world.

Now, with MDR, XDR and TDR having become everyday words with regard to TB, is it too late? Should the powers be reflect on the lack of action down the years and quickly take the action required? I think the answer is YES! We do not have the luxury of falling back on excuses to explain away our inaction.

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JATB features a press release from the Stop TB Partnership. This augurs well for TB Diagnosis.

The United States President’s Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID), UNITAID, and the Bill & Melinda Gates Foundation have announced an agreement that will significantly reduce the cost of the rapid TB diagnostic test Xpert MTB/RIF in 145 high-burden and developing countries.

Funds provided by this partnership will reduce the cost of Xpert MTB/RIF cartridges from $16.86 to $9.98, a price which will not increase until 2022. The effective date of this price decrease is 6 August 2012.

To date, the high unit cost of Xpert MTB/RIF cartridges produced by the medical device manufacturer Cepheid has proven a barrier to their introduction and widespread use in low- and middle-income countries. The new agreement will immediately reduce the cost of cartridges used to diagnose TB by more than 40%. Xpert is a molecular diagnostic system that can detect TB disease in patients co-infected with HIV and resistance to the antibiotic rifampicin – a widely accepted indicator of the presence of multi-drug resistant TB – in less than two hours. The system also can be used outside of conventional laboratories because it is self-contained and does not require specialized training. The World Health Organization (WHO) endorsed the Xpert MTB/RIF assay in December 2010.

“We are proud that the WHO Stop TB Department and Stop TB Partnership laid the groundwork for this exciting initiative by developing and advancing a proposal for UNITAID to lower the price of the Xpert test,” said Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership. “This agreement will translate into life-saving TB care for people affected by TB.”

Because TB is the leading cause of death among people living with HIV in Africa, greater access to the Xpert test offers a significant advance in the capacity of health care workers to diagnose TB quickly and help reduce TB transmission, the development of TB disease, and premature TB deaths.

“This is a game-changer for TB and MDR-TB care delivery and I applaud the visionary support of all partners and UNITAID” said Dr Mario Raviglione, Director of the WHO Stop TB Department. “We see innovation happening in real time – scientific evidence rapidly translated into policy, policy quickly adapted into practice, and scale-up significantly accelerated by innovative funding mechanisms effectively addressing cost and affordability.”

The capacity of the Xpert MTB/RIF assay to yield a rapid and accurate diagnosis has the potential to improve TB diagnosis and treatment in rural clinical settings. A large percentage of people with TB disease fail to start treatment promptly because of the long wait for results of older conventional tests and the need for them to return to the clinic, which may be far from where they live. Using the Xpert system, clinics in poor and rural settings can deliver rapid diagnosis and immediately start patients on appropriate treatment, including second-line drugs in cases of drug-resistant.

Research suggests that the incremental scale up of Xpert in countries with high TB burdens could allow for the rapid diagnosis of 700,000 cases of TB disease and save health systems in low- and middle-income countries more than U.S. $18 million in direct health costs.